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More than 20 cities and counties in Kansas have set the age at 21

Smoking exposes your throat to heat and harmful chemicals, which leads to: Sore throat due to smoking Persistent dryness and irritation Throat pain after smoking Even occasional smokers may experience discomfort, while regular smoking can lead to chronic throat problems

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PMID 1636327

While an irrefutable link has yet to be established, these substances have been implicated with coughing, wheezing, shortness of breath, asthma, and bronchiolitis obliterans (also known as Popcorn Lung)